Provider Demographics
NPI:1164694972
Name:GREENFIELD, SHANNON (PHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT VINCENT CIR STE 260
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5421
Mailing Address - Country:US
Mailing Address - Phone:501-552-4755
Mailing Address - Fax:501-552-4325
Practice Address - Street 1:1 SAINT VINCENT CIR STE 260
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5421
Practice Address - Country:US
Practice Address - Phone:501-552-4755
Practice Address - Fax:501-552-4325
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR99-13P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U626Medicare UPIN